Parkinsonism is a debilitating syndrome, encompassing several neurological diseases that compromise the motor skills of its victims. Such diseases include Parkinson's Disease, vascular Parkinsonism, Normal Pressure Hydrocephalus (NPH), multiple systems atrophy (MSA), progressive supranuclear palsy (PSP), and others. Globally, Parkinsonism and other such diseases are referred to as extrapyramidal disorders. As parkinsonism progresses, one particularly debilitating problem is “Freezing of Gait” (FOG), in which an individual locks up or becomes so fixated they are unable to move or initiate further stepping movements by their own volition. In some cases the individual feels “stuck to the floor” as if by a magnetic force. Unfortunately, FOG is not responsive to available medications. As a result, FOG poses a significant risk of injury to individuals if they are left unattended, even when trying to perform the most mundane tasks, and especially when they are in public settings, such as trying to cross a street. Accordingly, individuals suffering from FOG require constant monitoring and assistance.
A related problem which often occurs concomitantly in patients with FOG is gait hypokinesia. Gait hypokinesia entails patients taking with FOG is gait hypokinesia. Gait hypokinesia entails patients taking increasingly smaller steps. In a similar fashion to FOG, gait hypokinesia is often refractory to medications. A result can be that patients ambulate so slowly that they become discouraged and may increasingly opt to use a wheelchair or motorized scooter. However, by being able to walk, patients can prevent muscle atrophy, maintain cardiovascular health and bone density, and preserve a positive psychological outlook. Moderate exercise, or walking, has also been shown to correlate with a decreased likelihood of developing cognitive impairment such as Alzheimer's disease.
The incidence of Parkinson's disease is reported as 1% of the population over the age of 50, and 1.5% over the age of 65, with some occurrence in younger individuals but negligible incidence in children. Over half a million people in the United States are afflicted with this condition. Parkinsonism has an even broader impact with an occurrence of 30% over age 75 (where vascular Parkinsonism as the most common) and at ages over 85, more than 50% suffer some form of Parkinsonism.
People have attempted to manage these FOG episodes in various ways. The management techniques usually involve playing a “trick” on the brain. One technique that some use is to march or rock to sound cues such as marching music or counting. Another method is to provide some visual cue that encourages the feet to step up and over, as if unsticking from glue, rather than stepping forward, as with regular walking. These tricks are usually taught in the physician's office by the doctors, nurses, and therapists who are familiar with the symptoms. People also learn the methods from reading books about Parkinson's disease or by attending support group meetings. Because actual visual cues are often impractical outside of a controlled and prepared environment, such as a therapist's office, some are taught to draw an imaginary line in front of the afflicted person's feet and encourage him or her to “step up and over the imaginary line.” Also used is the dropping or placing of objects on the floor in front of the person's feet; forcing them to step over the object (paper, tissue, straws, belts, and the like). Virtually any object can be used to “step up and over.” A number of these methods are disclosed in U.S. Pat. Nos. 5,575,294; 6,330,888; US 2004/0144411; US 2006/0292533; and US 2007/0255186.
FIG. 1 is an illustration of an example prior art system 10 for projecting a visual cue to alleviate FOG in an individual such as that described in U.S. Patent Publication No. 2006/0025836, hereby incorporated by reference. The device includes a battery pack or power source 20 that is connected to light source 15. Light source 15 is configured to project a visual shape or pattern. System 10 includes clip 25 for attaching light source 15 to a user or object. Generally, clip 25 is configured to attach to an article of the user's clothing, such as a belt, shoe, or waistband such that light source 15 directs the visual shape or pattern on the ground ahead of the user while the user walks.
Prior art projection systems such as that shown in FIG. 1 have several disadvantages. First, when attached to an article of the user's clothing, the position of light source changes as the user moves. Because the light source can shift around, at the time a user is affected by FOG, it is extremely unlikely that the light source will be correctly oriented to assist the user. Similarly, if the user is shaking or trembling, the light source will be affected by those movements, resulting in the visual pattern shaking violently over whatever surface the light source is oriented towards. Furthermore, because the pattern is projected some distance away from the light source, even the smallest movement of the user is magnified making the device extremely difficult to use.
Although the prior art systems may be attached to surfaces or objects that are relatively more stable, such as a cane, or walker, in order to provide a connection sufficient to fix the light source to the object safely, any such clip or attachment device must be extremely strong. Such a clip could be extremely difficult for an elderly person, or a person suffering from Parkinsonism or similar disease, to operate. As a result, conventional project systems such as that illustrated in FIG. 1 are of little benefit to a user suffering from FOG and gait hypokinesia. Furthermore, in many prior art devices the visual cue is directed an unhelpful position within the user's stride. Some devices, for example, generate a visual line that cannot be moved and projects onto a walking surface at approximately the level of a patient's heels.
The aforementioned systems have been helpful to people, but each has drawbacks. Sound cues (such as marching music) are not often feasible, particularly outside the home, and many find singing or counting aloud embarrassing. Dropping or placing items on the floor requires not only that you have the objects ready to use but that someone be available to place and retrieve the objects. One alternative to this is to use small disposable objects, such as cards, and leave the object(s) behind. With other objects, if the object is 3-dimensional, such as a belt, the individual could trip and fall. The imaginary line method works well, but again, someone usually must accompany the individual to draw the line with their foot or hand. Some patients find it difficult to imagine a line during the freezing episode and remain unable to move until involuntary release occurs.
The visual stimulations proposed also do not meet all of the needs of the user. The visual images are not adjustable in that they do not turn in the direction of the user's motion. Also, the challenges of different light conditions between indoors and outdoors are not addressed. Often, a Parkinsonian patient will just sit down and stop what he or she is doing. At the present time, these homemade tricks or clip-on devices are the only mechanical techniques available to individuals in the United States who suffer from freezing and gait hypokinesia. For many people, the above-listed techniques are too impractical to consider using consistently. Thus, there is a need for a system to assist sufferers of FOG, and gait hypokinesia that does not contain the above drawbacks.